If you want help filling out this form please contact the Parent Information Center at 617-625-6600 x6962. If no one is there to answer the phone please leave a message and someone will return your call right away. Thank you!

Please use the secure form below to report an incident(s) of bullying, cyberbullying, or retaliation.

If you prefer you can also file an anonymous report of bullying, cyberbullying or retaliation by leaving a voice mail at the Somerville Public Schools' bullying hotline 617-629-5222 or by emailing bullying@k12.somerville.ma.us. If you choose to send an email report please consider using an email account that does not identify you by name.

The Director of Student Services will begin a preliminary investigation of this anonymous report as soon as it is received. If necessary the Principal/designee of the School(s) being affected by the incident(s) you are reporting here.

Please be aware that we will not administer any disciplinary actions solely on the basis on an anonymous report. There are consequences for making a false allegation of bullying.

Please tell us about the bullying

Before schoolDuring the school dayAfter schoolOn a weekend or other day off from schoolOther

If you answered "other" please give us more information

* Where did the bullying happen (check all that apply)

On the walk or bus ride between school and homeOn the tot lot/in the school yardIn the bathrooms at schoolIn the hallways at schoolIn the classroom or gymIn the cafeteriaIn the afterschool classroomCell phone or text messageFacebook, My Space, Twitter or other IM or Internet siteOther

If you answered "other" please give us more information

Did anyone try to stop the incident when it was happening?

YesNoNot sure

If you answered yes, can you please describe what happened to try to stop the incident?

Please tell us as much as you can about the people involved

The word "target" means the person who was bullied.

The word "aggressor" means the person who was doing the bullying.

The word "bystander" means people who might have seen or heard the incident as it was happening. This might be someone who saw a fight, read something on Facebook, or saw a text between two people.

There is often more than one target and one aggressor involved in bullying incidents. Please give us as much information as you can about all of the people involved.

* Please share the first and last name of at least one of the student(s) who were the targets of the bullying. If you don't know the student's full name please put as much as you know here.

* Where do the target(s) go to school? If there is more than one target and the targets go to different schools please check ALL the schools involved.

If one or more of the aggressors don't go to a Somerville public school please list the name of the school(s) they attend here.

Please list the name of any teacher(s) or other adult(s) who might have seen the incident.

Please list the name of any other children, teens or young people who might have seen the incident.

Do you know of any bullying that has happened between these people before this incident?

YesNoNot sure

Please tell us about you

* How did you find out about this incident? (check all that apply)

I was involved in the incidentI was a witness to the incidentI am the parent/guardian of a student involvedI am a teacher, staff or volunteer who was told about the bullying by someone elseI am a student who was told about the bullying by someone elseOther